scholarly journals Characteristics and practices of school-based cluster randomised controlled trials for improving health outcomes in pupils in the United Kingdom: a methodological systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kitty Parker ◽  
Michael Nunns ◽  
ZhiMin Xiao ◽  
Tamsin Ford ◽  
Obioha C. Ukoumunne
Keyword(s):  
United Kingdom ◽  
Health Outcomes ◽  
Primary Schools ◽  
School Setting ◽  
Sample Size Calculation ◽  
School Level ◽  
The United Kingdom ◽  
School Based ◽  
Cluster Randomised ◽  
Study Characteristics

Abstract Background Cluster randomised trials (CRTs) are increasingly used to evaluate non-pharmacological interventions for improving child health. Although methodological challenges of CRTs are well documented, the characteristics of school-based CRTs with pupil health outcomes have not been systematically described. Our objective was to describe methodological characteristics of these studies in the United Kingdom (UK). Methods MEDLINE was systematically searched from inception to 30th June 2020. Included studies used the CRT design in schools and measured primary outcomes on pupils. Study characteristics were described using descriptive statistics. Results Of 3138 articles identified, 64 were included. CRTs with pupil health outcomes have been increasingly used in the UK school setting since the earliest included paper was published in 1993; 37 (58%) studies were published after 2010. Of the 44 studies that reported information, 93% included state-funded schools. Thirty six (56%) were exclusively in primary schools and 24 (38%) exclusively in secondary schools. Schools were randomised in 56 studies, classrooms in 6 studies, and year groups in 2 studies. Eighty percent of studies used restricted randomisation to balance cluster-level characteristics between trial arms, but few provided justification for their choice of balancing factors. Interventions covered 11 different health areas; 53 (83%) included components that were necessarily administered to entire clusters. The median (interquartile range) number of clusters and pupils recruited was 31.5 (21 to 50) and 1308 (604 to 3201), respectively. In half the studies, at least one cluster dropped out. Only 26 (41%) studies reported the intra-cluster correlation coefficient (ICC) of the primary outcome from the analysis; this was often markedly different to the assumed ICC in the sample size calculation. The median (range) ICC for school clusters was 0.028 (0.0005 to 0.21). Conclusions The increasing pool of school-based CRTs examining pupil health outcomes provides methodological knowledge and highlights design challenges. Data from these studies should be used to identify the best school-level characteristics for balancing the randomisation. Better information on the ICC of pupil health outcomes is required to aid the planning of future CRTs. Improved reporting of the recruitment process will help to identify barriers to obtaining representative samples of schools.

scholarly journals Characteristics and practices of school-based cluster randomised controlled trials for improving health outcomes in pupils in the UK: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044143
Author(s):  
Kitty Parker ◽  
Michael P Nunns ◽  
ZhiMin Xiao ◽  
Tamsin Ford ◽  
Obioha C Ukoumunne
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Data Extraction ◽  
School Setting ◽  
Secondary Data ◽  
Health Interventions ◽  
School Based ◽  
Cluster Randomised ◽  
Methodological Considerations ◽  
The Uk

IntroductionCluster randomised trials (CRTs) are studies in which groups (clusters) of participants rather than the individuals themselves are randomised to trial arms. CRTs are becoming increasingly relevant for evaluating interventions delivered in school settings for improving the health of children. Schools are a convenient setting for health interventions targeted at children and the CRT design respects the clustered structure in schools (ie, pupils within classrooms/teachers within schools). Some of the methodological challenges of CRTs, such as ethical considerations for enrolment of children into trials and how best to handle the analysis of data from participants (pupils) that change clusters (schools), may be more salient for the school setting. A better understanding of the characteristics and methodological considerations of school-based CRTs of health interventions would inform the design of future similar studies. To our knowledge, this is the only systematic review to focus specifically on the characteristics and methodological practices of CRTs delivered in schools to evaluate interventions for improving health outcomes in pupils in the UK.Methods and analysisWe will search for CRTs published from inception to 30 June 2020 inclusively indexed in MEDLINE (Ovid). We will identify relevant articles through title and abstract screening, and subsequent full-text screening for eligibility against predefined inclusion criteria. Disagreements will be resolved through discussion. Two independent reviewers will extract data for each study using a prepiloted data extraction form. Findings will be summarised using descriptive statistics and graphs.Ethics and disseminationThis methodological systematic review does not require ethical approval as only secondary data extracted from papers will be analysed and the data are not linked to individual participants. After completion of the systematic review, the data will be analysed, and the findings disseminated through peer-reviewed publications and scientific meetings.PROSPERO registration numberCRD42020201792.

scholarly journals The developing role of occupational therapists in school-based practice: Experiences from collaborative action research in Pakistan

2020 ◽  
Vol 83 (6) ◽  
pp. 375-386
Author(s):  
Debbie Kramer-Roy ◽  
Denise Hashim ◽  
Nighat Tahir ◽  
Areeba Khan ◽  
Asma Khalid ◽  
...  
Keyword(s):  
Action Research ◽  
Occupational Therapy ◽  
Inclusive Education ◽  
Primary Schools ◽  
Occupational Therapists ◽  
Collaborative Action Research ◽  
School Level ◽  
Collaborative Action ◽  
School Based

Introduction Occupational therapists around the world increasingly seek to support the participation of children with disabilities and special educational needs in mainstream education. Contemporary school-based occupational therapy practice is progressing from an individual, impairment focus towards collaborative, universal interventions at the whole class and whole school level. Participation-focused practice and collaboration is particularly important, but uncommon, in low-resource contexts such as Pakistan. Methods This article reports on collaborative action research that developed the role of occupational therapy in inclusive education in Karachi, Pakistan. A research team consisting of occupational therapists and teachers worked with five local primary schools, using the action research cycles of plan–implement–observe–reflect to develop practical strategies, materials and inclusive lesson plans to facilitate the participation of all children in all school-based occupations. Findings Support from school management and interdisciplinary collaboration were crucial for implementing change. In addition, strategies like inclusive lesson planning were found to benefit all children in class. Collaborative action research led to increased professional confidence in the teachers and occupational therapists, and skill development through developing a resource guide, running workshops and presenting at (inter)national conferences. Conclusion Collaborative action research was an effective means to develop the occupational therapy role in inclusive education practices in Pakistan, develop culturally appropriate educational resources, and upskill local therapists and teachers.

The global effectiveness of fact-checking: Evidence from simultaneous experiments in Argentina, Nigeria, South Africa, and the United Kingdom

2021 ◽  
Vol 118 (37) ◽  
pp. e2104235118 ◽  
Author(s):  
Ethan Porter ◽  
Thomas J. Wood
Keyword(s):  
South Africa ◽  
United Kingdom ◽  
Health Outcomes ◽  
False Beliefs ◽  
Point Scale ◽  
Analytic Procedure ◽  
The United Kingdom ◽  
Fact Checking ◽  
Checking Experiments

The spread of misinformation is a global phenomenon, with implications for elections, state-sanctioned violence, and health outcomes. Yet, even though scholars have investigated the capacity of fact-checking to reduce belief in misinformation, little evidence exists on the global effectiveness of this approach. We describe fact-checking experiments conducted simultaneously in Argentina, Nigeria, South Africa, and the United Kingdom, in which we studied whether fact-checking can durably reduce belief in misinformation. In total, we evaluated 22 fact-checks, including two that were tested in all four countries. Fact-checking reduced belief in misinformation, with most effects still apparent more than 2 wk later. A meta-analytic procedure indicates that fact-checks reduced belief in misinformation by at least 0.59 points on a 5-point scale. Exposure to misinformation, however, only increased false beliefs by less than 0.07 points on the same scale. Across continents, fact-checks reduce belief in misinformation, often durably so.

scholarly journals A school-based oral health educational program: the experience of Maringa- PR, Brazil

2004 ◽  
Vol 12 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Carlos Alberto Conrado ◽  
Sandra Mara Maciel ◽  
Márcia Regina Oliveira
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Oral Hygiene ◽  
Primary Schools ◽  
Oral Health Care ◽  
School Level ◽  
Educational Approach ◽  
Entire Study ◽  
School Based ◽  
Study Population

The main purpose of this study was to evaluate the preliminary results of a school-based oral health educational strategy adopted in public primary schools from the city of Maringa, State of Parana, Brazil. The study sample was composed by 556 children and adolescents aged 6 to 17 years old, 124 schoolteachers and a group of 55 mothers. The educational approach was implemented for 18 months and consisted of reinforcements of interventions addressed to students and schoolteachers at school level and few activities targeted at the mothers, performed by means of home visits. Baseline and follow-up interviews focused on oral health care were undertaken for the entire study population. As a stimulus for the students to achieve proper oral hygiene habits, the simplified oral hygiene index was assessed at three different moments. A statistically significant improvement in their oral hygiene index (p<0.001) was recorded. The results achieved suggest an encouraging tendency towards the improvement in the levels of oral health care among the school-age youths studied. They also point out the need of intensifying the preparation of schoolteachers in oral health topics, as well the instructions to the mothers for their oral health care. Moreover, they highlight the importance of the continuous implementation of school-based programs to promote the oral health.

scholarly journals Impact of a school-based water, sanitation and hygiene programme on children’s independent handwashing and toothbrushing habits: a cluster-randomised trial

2020 ◽  
Vol 65 (9) ◽  
pp. 1699-1709
Author(s):  
Denise Duijster ◽  
Helen Buxton ◽  
Habib Benzian ◽  
Jed Dimaisip-Nabuab ◽  
Bella Monse ◽  
...  
Keyword(s):  
Primary Schools ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Monday Morning ◽  
Daily Group ◽  
School Based ◽  
Cluster Randomised ◽  
Sanitation And Hygiene ◽  
Filipino Children ◽  
And Control

Abstract Objectives To explore whether a school-based water, sanitation and hygiene programme, which includes group hygiene activities, contributes to the formation of independent handwashing and toothbrushing habits among Filipino children. Methods In this cluster-randomised trial, twenty primary schools were randomly allocated to the intervention or control arm. Intervention schools received group handwashing facilities and implemented daily group handwashing and toothbrushing activities. A soap use to toilet event ratio was calculated to measure children’s independent handwashing behaviour after toilet use, and dental plaque accumulation on Monday morning was measured as a proxy indicator for children’s independent toothbrushing behaviour at home. Results Four months after implementation, handwashing and toothbrushing behaviours did not significantly differ between intervention and control schools. The mean soap use in intervention schools and control schools was 0.41 g and 0.30 g per toilet event, respectively (p = 0.637). Compared to baseline, mean plaque scores reduced by 4.2% and 3.5% in intervention and control schools, respectively (p = 0.857). Conclusions Although health benefits have been established, school-based group handwashing and toothbrushing may not be sufficient to increase children’s uptake of independent hygiene behaviours.

scholarly journals International mental health outcomes and benchmarking using the FACE approach

2001 ◽  
Vol 24 (3) ◽  
pp. 105 ◽  
Author(s):  
Rob Elzinga ◽  
Fiona Meredith & Paul Clifford
Keyword(s):  
Mental Health ◽  
United Kingdom ◽  
Health Outcomes ◽  
Mental Health Outcomes ◽  
Care Plan ◽  
Service Users ◽  
Similar Treatment ◽  
The United Kingdom ◽  
Physical Problems ◽  
The Face

This article describes and compares the nature and severity of problems encountered by persons receiving mental healthservices in the United Kingdom and Australia, and the outcome of their treatment. The perspective of service providersand service users in the two countries was strikingly similar. Treatment was effective in alleviating problems withsocial circumstances, and in increasing adaptive and interpersonal functioning. Treatment was less effective inaddressing psychological or physical problems. Service users in the United Kingdom were more involved in developingtheir treatment care plan than those in Australia. The study demonstrates how data required for benchmarking andoutcome evaluation purposes can be generated as part of routine clinical processes.

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